Protective Factors in Forensic Practice: The Added Value of the SAPROF-Extended Version Pilot in Relation to Aggressive Incidents

• Published date: 01 November 2023
• DOI: http://doi.org/10.1177/00938548231196572
• Author: Leen Cappon,Armin Jentsch,Saskia Roggeman,Michiel de Vries Robbé
• Date: 01 November 2023
• Subject Matter: Articles

CRIMINAL JUSTICE AND BEHAVIOR, 2023, Vol. 50, No. 11, November 2023, 1603 –1622.

DOI: https://doi.org/10.1177/00938548231196572

Article reuse guidelines: sagepub.com/journals-permissions

© 2023 International Association for Correctional and Forensic Psychology

1603

PROTECTIVE FACTORS IN FORENSIC

PRACTICE

The Added Value of the SAPROF-Extended Version

Pilot in Relation to Aggressive Incidents

LEEN CAPPON

Psychiatric Center Sint-Jan-Baptist, ScienceForCare

ARMIN JENTSCH

University of Greifswald

SASKIA ROGGEMAN

Psychiatric Center Sint-Jan-Baptist, ScienceForCare

MICHIEL DE VRIES ROBBÉ

Amsterdam University Medical Center

McMaster University

Protective factors are now commonly included in comprehensive risk assessment. This study concerns an initial validation

of the new SAPROF-Extended Version (SAPROF-EV) pilot, containing modifications and additions to the original SAPROF.

For 139 forensic psychiatric inpatients, assessment results with the SAPROF-EV pilot and HCR-20V3 were compared with

aggressive incidents. Results show good predictive validity for the SAPROF-EV pilot for all outcomes and incremental

predictive validity for both the (modified) original SAPROF and the full SAPROF-EV pilot over the HCR-20V3. For the

outcome aggression toward others, the additional SAPROF-EV factors provide incremental predictive validity over the

(modified) original SAPROF. In addition, the user feedback from clinicians highlights experienced additional value of the

new factors for treatment guidance. Based on the findings from this study, the SAPROF-EV pilot will be adjusted further into

an improved and enhanced version of the SAPROF.

Keywords: SAPROF; protective factors; risk assessment; predictive validity; aggression

AUTHORS’ NOTE: We would like to thank the criminologists of Psychiatric Center Sint-Jan-Baptist for their

efforts in scoring the pilot version of the SAPROF-EV and their participation in the focus group. Without their

efforts, we would not have been able to complete this research. Correspondence concerning this article should

be addressed to L. Cappon, Department of Research, Psychiatric Center Sint-Jan-Baptist, Suikerkaai 81, 9060

Zelzate, Belgium; e-mail: leen.cappon@janbaptist.broedersvanliefde.be.

1196572CJBXXX10.1177/00938548231196572Criminal Justice and BehaviorCappon et al. / NEW PROTECTIVE FACTORS IN FORENSIC PRACTICE

research-article2023

1604 CRIMINAL JUSTICE AND BEHAVIOR

INTRODUCTION

The first goal of forensic psychiatric treatment is to prevent recidivism by addressing

factors related to future violent behavior (Nedopil, 2009). Therefore, repeated and accurate

risk assessment is needed during treatment to determine which specific criminogenic needs

should be addressed to protect society (Neves et al., 2019). Currently, various structured

instruments for risk assessments of adults are available (Hogan & Olver, 2019). One of the

most widely used risk assessment instruments in forensic clinical practice is the HCR-20V3

(Douglas et al., 2013). Meta-analytic and systematic reviews have shown that structured

risk-only assessment instruments are generally fairly good predictors of future (inpatient)

violence (e.g., Fazel et al., 2022; Hogan & Ennis, 2010; Ramesh et al., 2018). This is also

found for the HCR-20V3 (Douglas & Shaffer, 2020).

In addition to targeting risk factors, forensic psychiatric treatment aims to promote secure

recovery (i.e., restoration of mental health and social functioning) to enable safe reintegra-

tion into society (Nedopil, 2009; Neves et al., 2019). To address this second—but equally

important to the first—goal, scholars and treatment providers have started challenging the

one-sided view of altering an individual’s potential for future violence through diminishing

risk factors alone (Rogers, 2000). There is a growing acknowledgment from different disci-

plines—such as the desistance paradigm (criminology; Maruna & LeBel, 2010) and the

Good Lives Model (forensic psychology; Ward, 2002)—of the importance of reinforcing

strengths in forensic psychiatric patients (Vandevelde et al., 2017).

From these two goals—prevent recidivism as much as possible and promote secure

recovery as well as possible—the addition of protective factors in risk assessment appears

to be able to provide a valuable contribution. Explicitly evaluating and strengthening pro-

tective factors for an individual is recognized as helpful to identify assets that reduce overall

risk level and to support defensible decision-making to prevent future violence (Doyle

et al., 2021). Positive, strengths-based treatment programs are considered to contribute to

the prevention of future violence (Fortune et al., 2011). A profound evaluation of protective

factors can help to better tailor strengths-based interventions and to offer improved oppor-

tunities for rehabilitation within a more person-oriented approach in forensic practice, even

for high-risk individuals (Olver & Riemer, 2021).

Protective factors could be defined as characteristics of a person, their environment, or

the situation which enable or assist desistance from offending for those who have already

offended or prevent the onset of offending among at-risk populations (De Vries Robbé,

Mann et al., 2015). They can be found in the person’s history but are often dynamic personal

attributes, motivational factors or external environmental circumstances (Neves et al.,

2019). Including the positive focus of personal and situational strengths could potentially

improve the predictive validity of violence risk assessment and enhance its clinical utility.

Protective factors can provide additional optimistic treatment targets and offer hope and

inspiration for rehabilitation (De Vries Robbé & Willis, 2017).

One commonly used tool developed to explicitly assess protective factors is the Structured

Assessment of Protective Factors for violence risk (SAPROF; De Vogel et al., 2009; 2nd

Edition 2012). This tool was designed to complement risk-focused assessment tools, such

as the HCR-20V3. In the past decade, the SAPROF has been widely studied and evaluated

in different settings and countries. Overall, good interrater reliability and predictive validity

for desistance from violent recidivism, sexual recidivism, institutional misconduct and